Purpose. to analyze the survivorship of the RSA with a minimum 10 years follow up. Patients and Methods. Between 1992 and 1999, 145 Delta (DePuy) RSAs have been implanted in 138 patients. It was a mulicentric study. Initial etiologies were gathered as following: group A (92 cases) Cuff tear arthropaties (CTA), osteoarthritis (OA) with at least 2 involved cuff tendons, and massive cuff tear with pseudoparalysis (MCT); group B (39 cases) -failed hemiarthroplasties (HA), failed total shoulder arthroplasties (TSA), and fracture sequelae; and group C (14 cases) rheumatoid arthritis, fractures, tumor, and instability. Survival curves were established with the Kaplan-Meier technique. Two end-points were retained: -implant revision, defined by glenoid or humeral replacement or removal, or conversion to HA; - a poor clinical outcome defined by an absolute Constant score of less than 30. Results. At the time of review, 47 patients had died with their prosthesis in place and 30 were lost to follow-up. There were 12 revisions, 6 for infections, 3 for glenoid loosening, 1 for dislocation, 1 for glenoid dissociation (by unscrewing), and 1 for humeral loosening. The survival curve to prosthetic removal showed an overall survivorship of 92% at 10 years. Segmentation according to etiology showed a 97% survivorship for group A and 88% for group B This difference was not significant. No patients of group C had a minimum follow up of ten years because there were died or lost to follow up. The survival curve to a Constant score of less than 30 showed an overall survivorship of 90% at 10 years. Segmentation according to etiology showed a significant difference at 10 years in favor of group A (92%) compared to group B (86%) with a break of the curve after 9 years for group B. Discussion. Our results show that the overall survivorship of the
Reverse shoulder replacement is a surgical option for cuff tear arthropathy. However scapular notching is a concern. Newer designs of glenospheres are available to reduce scapular notching. Eccentric glenosphere with a lowered centre of rotation have been shown to improve range of adduction in vitro. We hypothesize that the eccentric glenosphere improve clinical outcomes and reduce scapular notching. This is an ongoing randomized controlled double blind prospective clinical trial. Patients 70 years or older at North Shore hospital who have a diagnosis of cuff tear arthropathy and require surgery were consented for this study. Patients were allocated a concentric or eccentric 36 mm glenosphere intraoperatively, using a computer generated randomization contained in a sealed envelope. The surgical technique and post operative rehabilitation were standardized. Patients were followed up by a research nurse and postoperative radiographs were also taken at regular intervals. Clinical assessment include a visual analogue pain score, subjective shoulder rating, American Shoulder and Elbow Society Score, and Oxford shoulder score. Complications were checked for and radiographs were assessed for scapular notching.Introduction
Method
The PROximal Fracture of the Humerus Evaluation by Randomisation
(PROFHER) randomised clinical trial compared the operative and non-operative
treatment of adults with a displaced fracture of the proximal humerus
involving the surgical neck. The aim of this study was to determine
the long-term treatment effects beyond the two-year follow-up. Of the original 250 trial participants, 176 consented to extended
follow-up and were sent postal questionnaires at three, four and
five years after recruitment to the trial. The Oxford Shoulder Score
(OSS; the primary outcome), EuroQol 5D-3L (EQ-5D-3L), and any recent
shoulder operations and fracture data were collected. Statistical
and economic analyses, consistent with those of the main trial were
applied.Aims
Patients and Methods
The aims of this study were to estimate the cost of surgical
treatment of fractures of the proximal humerus using a micro-costing
methodology, contrast this cost with the national reimbursement
tariff and establish the major determinants of cost. A detailed inpatient treatment pathway was constructed using
semi-structured interviews with 32 members of hospital staff. Its
content validity was established through a Delphi panel evaluation.
Costs were calculated using time-driven activity-based costing (TDABC)
and sensitivity analysis was performed to evaluate the determinants
of costAims
Methods
We used an inverted shoulder arthroplasty in 43 consecutive patients with a mean age of 78 years (65 to 97) who had sustained a three- or four-part fracture of the upper humerus. All except two were reviewed with a mean follow-up of 22 months (6 to 58). The clinical outcome was satisfactory with a mean active anterior elevation of 97° (35° to 160°) and a mean active external rotation in abduction of 30° (0° to 80°). The mean Constant and the mean modified Constant scores were respectively 44 (16 to 69) and 66% (25% to 97%). Complications included three patients with reflex sympathetic dystrophy, five with neurological complications, most of which resolved, and one with an anterior dislocation. Radiography showed peri-prosthetic calcification in 36 patients (90%), displacement of the tuberosities in 19 (53%) and a scapular notch in ten (25%). Compared with conventional hemiarthroplasty, satisfactory mobility was obtained despite frequent migration of the tuberosities. However, long-term results are required before reverse shoulder arthroplasty can be recommended as a routine procedure in complex fractures of the upper humerus in the elderly.
